Sage Journals: Discover world-class research

Abstract

Objective

The crural diaphragm is responsible for pulmonary ventilation in the early period after lobectomy. However, the role of its thickness in pulmonary ventilation remains unclear. We investigated the impact of crural diaphragm thickness on pulmonary oxygenation and gas exchange early after lobectomy.

Methods

We enrolled 32 patients with non-small-cell lung cancer who underwent video-assisted thoracoscopic lobectomy. Crural diaphragm thickness was defined as the average of the maximum thicknesses of the right and left crural diaphragm at the level of the median arcuate ligament on computed tomography. Pulmonary oxygenation and gas exchange were evaluated by the ratio of arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference on the second postoperative day.

Results

Crural diaphragm thickness of 7.0 ± 1.7 mm was associated with vital capacity. After lobectomy, arterial oxygen tension/fraction of inspiratory oxygen decreased significantly and alveolar-arterial oxygen difference increased significantly. Five patients with oxygen saturation via pulse oximetry ≤92% had a lower arterial oxygen tension/fraction of inspiratory oxygen and higher alveolar-arterial oxygen difference than the others. Crural diaphragm thickness in these patients was less than in the others (5.5 ± 1.9 vs. 7.3 ± 1.5 mm, p = 0.033). In multivariate analysis, crural diaphragm thickness remained an independent factor affecting arterial oxygen tension/fraction of inspiratory oxygen and alveolar-arterial oxygen difference (p = 0.044, p = 0.049). Crural diaphragm thickness was positively associated with arterial oxygen tension/fraction of inspiratory oxygen and negatively associated with alveolar-arterial oxygen difference.

Conclusion

Crural diaphragm thickness affects pulmonary ventilation early after lobectomy.

Keywords

Diaphragm pneumonectomy pulmonary gas exchange respiratory function tests respiratory muscles thoracoscopic surgery video-assisted

Get full access to this article

View all access options for this article.

References

Nomori

Kobayashi

Fuyuno

Morinaga

and Yashima

Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications.

Chest 1994; 105: 1782–1788.

Weiner

Man

Weiner

et al . The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. J Thorac Cardiovasc Surg 1997; 113: 552–557.

Ziyade

Baskent

Tanju

Toker

and Dilege

Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy.

Thorac Cardiovasc Surg 2010; 58: 295–298.

Subotic

Stevic

Gajic

and Vesovic

Diaphragm motion and lung function prediction in patients operated for lung cancer—a pilot study on 27 patients. J Cardiothorac Surg 2013: 18(8): 213.

Nakata

Saeki

Yokoyama

Kurita

Takiyama

and Takashima

Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy.

Ann Thorac Surg 2000; 70: 938–941.

Cohn

Benditt

Eveloff

and McCool

FD.

Diaphragm thickening during inspiration.

J Appl Physiol 1997; 83: 291–296.

Varela

Brunelli

Rocco

et al . Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg 2006; 30: 644–648.

O’Driscoll

Howard

Earis

Mak

; British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72(Suppl 1): ii1–90.

Gomez-Perez

Haus

Sheean

et al . Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image: a step-by-step guide for clinicians using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr 2016; 40: 308–318.

10.

Huang

Hennon

and Demmy

TL.

Video-assisted thoracoscopic surgery for wedge resection, lobectomy and pneumonectomy. In: LoCicero

III , Feins

Colson

Rocco

, editors. Shields’ General Thoracic Surgery. 8th ed. Philadelphia: Wolters Kluwer, 2018;457–496.

11.

Kanda

Investigation of the freely available easy-to-use software ‘EZR' for medical statistics.

Bone Marrow Transplant 2013; 48: 452–528.

12.

Onders

RP.

Physiology of the diaphragm and surgical approaches to the paralyzed diaphragm. In: LoCicero

III , Feins

Colson

Rocco

, editors. Shields’ General Thoracic Surgery. 8th ed. Philadelphia: Wolters Kluwer, 2018: 664–672.

13.

Ahmet

Bayram, Cengiz Gebitekin. Embryology, anatomy and physiology of the diaphragm. In: Kuzdzat

, editor. ESTS Textbook of the Thoracic Surgery. Volume 2. Cholezyn: Medycyna Praktyczna, 2015: 169–174.

14.

American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518–624.

15.

Nason

Walker

McNeeley

Burivong

Fligner

and Godwin

JD.

Imaging of the diaphragm: anatomy and function.

Radiographics 2012; 32: E51–70.

16.

Baria

Shahgholi

Sorenson

et al . B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2014; 146: 680–685.

17.

Filaire

Bedu

Naamee

et al . Prediction of hypoxemia and mechanical ventilation after lung resection for cancer. Ann Thorac Surg 1999; 67: 1460–1465.

18.

Jones

Sapsford

and Wheatley

RG.

Postoperative hypoxaemia: mechanisms and time course.

Anaesthesia 1990; 45: 566–573.

19.

Catley

Thornton

Jordan

Lehane

Royston

and Jones

JG.

Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen.

Anesthesiology 1985; 63: 20–28.

20.

Ziarnik

and Grogan

EL.

Postlobectomy early complications.

Thorac Surg Clin 2015; 25: 355–364.

21.

Filaire

Bedu

Naamee

et al . Prediction of hypoxemia and mechanical ventilation after lung resection for cancer. Ann Thorac Surg 1999; 67: 1460–1465.

Impact of the crural diaphragm thickness on pulmonary function after lobectomy

Abstract

Objective

Methods

Results

Conclusion

Keywords

Get full access to this article

References